Reproductive
Weight stigma during pregnancy: The association between prepregnancy body mass index category, gestational weight gain, and adequate prenatal care communication Lisa Miller* Lisa Miller Miller Miller Miller Miller University of North Carolina at Chapel Hill
Background
Women with obesity frequently cite physicians as a source of weight bias, potentially limiting adequate prenatal care (PNC). We examined the association between prepregnancy body mass index (pBMI) and PNC provider communication and whether gestational weight gained (GWG) modifies this relationship.
Methods
Data were from the 2009 – 2011 Life-course Influences of Fetal Environments study, restricted to respondents with ≥ 1 PNC visit (N=1090). GWG was categorized per CDC guidelines as “less than recommended”, “recommended”, or “more than recommended”, and pBMI was classified as “overweight” (25-29.9 kg/m2), “obese” (≥30kg/m2), or “healthy weight” (18-24.9 kg/m2), with “healthy weight” as the reference. PNC communication covered 8 topics (e.g. early labor pains and alcohol use) and was operationalized as adequate (discussed/given guidance) or inadequate (not discussed). Logistic regression was used to estimate odds ratios (OR) and 95% CI for pBMI with PNC communication. Effect modification of pBMI across GWG levels was assessed. Models were adjusted for health behaviors (e.g. smoking), PNC adequacy, and sociodemographics.
Results
Among those who gained more weight than recommended, overweight participants were less likely to receive communication about early labor pains (OR: 0.41; 95% CI: 0.22-0.78) and obese participants were less likely to receive guidance on sleep (OR: 0.59; 95% CI: 0.37-0.95). Among those who gained less than weight recommended, overweight participants were less likely to receive guidance on sleep (OR: 0.32; 95% CI: 0.11-0.96) and obese participants were less likely to receive guidance about chronic health (OR: 0.40; 95% CI: 0.19-0.86) and alcohol use (OR: 0.37; 95% CI: 0.16-0.87).
Conclusion
Participants with an overweight or obese pBMI who deviate from GWG recommendations are less likely to receive adequate PNC communication. Findings indicate PNC providers may differentially prioritize communication depending on body size and GWG.